Letters. (Opinion).

Residency Scheduling

Residents' work hours have been limited for the past 12 years in New York state, where all training programs are mandated to be in compliance ("Duty Hours Dispute May Impact Private Physicians," May 15, 2002, p. 27).

Unplanned and unannounced state inspections are followed by penalties for violations. The limits include an 80-hour work week averaged over 4 weeks with no more than 24 consecutive hours. On-duty assignments must be separated by not less than 8 nonworking hours and residents must have at least one 24-hour period of scheduled nonworking time per week.

The specific number of scheduled hours of duty by residents was arbitrarily defined and, since implementation, data describing the impact on resident education and quality of patient care are nonexistent. Exploration of these questions is difficult because of the ever-changing environment of health care delivery and graduate medical education. Our experiences with implementation and compliance have highlighted scheduling difficulties, such as ensuring that residents' continuity clinic experience is not eroded.

Employing more ancillary staff such as physician assistants is costly and also affects continuity. A ripple effect of the specific work hours is the necessity for careful adherence to "change over times" and their effect on residents' clinical activities as these clock times are approached. Time-related issues have become a high priority in the minds of residents and faculty educators.

Sufficient flexibility is necessary to enable program directors to balance the educational requirements and process with patient care and regulations governing work hours.

Brian L. Cohen, M.D.